Increased sensitivity to a nondepolarizing muscle relaxant in a patient with acquired neuromyotonia

Greg Ginsburg, Ryan Forde, Jeevendra A.J. Martyn, Matthias Eikermann

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Neuromyotonia is a disorder of hyperexcitability of the peripheral nerve. It has electromyographic features of spontaneous, continuous, irregularly occurring doublets, or multiplets of motor unit potential discharges. Neuromyotonia is characterized by both myokymic and neuromyotonic discharges. To our knowledge, this is the first report in the literature to assess the sensitivity of skeletal muscle to a nondepolarizing muscle relaxant drug, rocuronium, in a woman with acquired neuromyotonia. She had a past medical history notable for prolonged postoperative paralysis following anesthesia. The patient showed increased sensitivity to the neuromuscular effects of rocuronium. This increase in sensitivity may be explained by downregulation of acetylcholine receptors in response to chronic high agonist (acetylcholine) concentrations. If patients with neuromyotonia receive anesthesia, we recommend that smaller doses of a nondepolarizing muscle relaxant be administered, accompanied by monitoring of neuromuscular function, so as to provide optimal muscle relaxation while avoiding overdose and prolonged postoperative recovery.

Original languageEnglish (US)
Pages (from-to)139-142
Number of pages4
JournalMuscle and Nerve
Issue number1
StatePublished - Jul 2009
Externally publishedYes


  • Acquired neuromyotonia
  • Isaacs syndrome
  • Nondepolarizing muscle relaxants
  • Rocuronium sensitivity
  • Voltage-gated potassium-channels

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Physiology (medical)


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